Orthobullet Tests Flashcards
Congenital Dislocation of Knee
Start with casting in flexion(4w)–>open procedure to quadriceps. THough to be quadriceps contracture
Short Head of Biceps Femoris Innervation?
Peroneal Division of Sciatic N.
All other hamstrings get from tibial division also both heads of gastroc
Botulinum Effect?
Decrease Release of Acetylcholine at NM JXN (pre-synaptic)
Myasthenia Gravis
Ig’s against acetylcholine receptors at NM JXN (post-synaptic). Tx acetylcholinesterase inhibitors and Thymectomy. Easy fatiguabilty, ptosis with upwards gaze
Dystrophin Effect?
acts to regulate CALCIUM influx at level of sacrolemma
Yield Point
Point on Stress/Strain when material goes from elastic behavior to plastic behavior
Terrible Triad?
Posteriorlateral elbow dislocation (LCL)
Coronoid Fracture
Radial Head Fracture
Aminoglycosides MOA?
30S Ribosomal Sub-unit
Penicilllin MOA?
Prevent bacterial cell wall synthesis
Macrolides MOA?
50S ribosomal sub-unit binding
Rifampin MOA?
inhibit RNA polymerase
Quinolones MOA?
DNA gyrase inhibition
With Knee Flexion Tibia/Femur Rotation?
Relative internal rotation of tibial about medial point, Relative lateral rotaitn of femur
How does distal lateral femur translate during knee flexion?
Posteriorly
Arthroscopic Lysis of adhesions considered ?
Usually after MUA failed for ROM, no infection, AFTER 3 months
Common problem after TKA revision?
Elevation of joint line (even with NL Flex/Ext gaps) need to augment femoral component
Snowboarders fracture?
Fracture of lateral process of talus (casting - ND, ORIF- displaced)
MSIS Major Criteria PJI
- Draining Sinus Tract
- Pathogen Isolation from 2 different samples
- 4 or 6 minor criteria
MSIS Minor Criteria
- ESR >30, CRP >10
- WBC >1,100 (synovial)
- Elevated PMN synovial WBC >70%
- Purulence in Joint
- > 5 PMN per HPF
- Organism isolated from 1 sample
Most common risk factor for humeral shaft non-union?
Vit D Deficiency
Tx: Compression plating and bone graft
Femoral Resurfacing vs THA
Better femoral bone stock preservation, High re-operation rates (loosening and femoral neck fracture), wear rate is same of both MonM
Acetabular Liner REvision associated with?
High dislocation rates
Ipsilateral Femoral Neck and Shaft Fractures treatment- Highest rates of mal-reduction?
Treatment with one implant: should use two separate implant devices
Patellectomy TKA?
lack of levear arm with patella decrases rate at which patella tendon prevents tibia from A–> P translation, stretched PCL/posterior capsule overtime (recurvatum), need to due Posterior substituting knee
Meniscus injury Risk Factures in Shatsker II
Joint depression >6mm
Joint Widening > 5mm
Remelting Versus Annealing?
Remelting removed MORE free-radicals but disrupts crystalline structure more. Therefore annealing has MORE free radicles but BETTER mechanical properties
Total Elbow in Elderly for complex distal humerus fracture?
- Better outcomes
- Better ROM
- Decreased REvision rates compared to ORIF
Cant lift more than 5-10 lb
Most common place for TB in spine?
Usually starts anterior, sparing of the disk space.
SSEP’s vs MEP
- SSEPS- not good at monitoring anterior spinal pathways, NOT effected by Anesthesia
- MEPS more sensitve and specific, CAN be effected by anesthesia
Most common site for vertebral TB in children?
anteiror aspect of lower THORacic spine. Usually DOES NOT violate endplate like bacterial infections do
Corticosteroids inhibit inflammatory process via inhibition of :
Phospholipase A2
Two types of CRPS?
- Reflex Sympothetic Dystrophy: no nerve lesions
2. Causalgia: may have assocaited nerve lesions
Middle glenohumeral ligament orientation to SS tendon when veiwing from posterior portal?
Crossed the posterior aspect of SS at 45d angle to insert on superrior labrum or glenoid
Vaughan-Jackson syndrome tendon ruptpure?
- attritional wear of the extensor digiti quinti tendon with rupture
EIP in the 4th dorsal compartment ?
is ULNAR and DEEP to EDC
- EIP has most distal muscle belly
Pseudogout clinical apppearance?
weakly positive bifringent: blue
- Chondrocalcinosis: articular cartilage and meniscus
IOM from radius and ulna?
- Central band and acessory bandrun from proximal radius to distal ulna orientation. All the other OLIBUE chords and band run from ulnar proximally to radius distally.
Keller Resection Arthroplasty patient?
- Lower demand
- NO dorsiflextion of proximal phalanx
- Loss of motion, significant joint degen
- removal of base of proximal phalanxx
Modic Type I Changes:
T1 Low, T2High signal(represented bone edema and inflammation)
Modic Type II (T1/T2)
T1 High (conversion to fatty marrow T2 High
Modic Type III (t1/T2)
T1 low, T2 Low- sclerosis
Weil shortening osteotomy:
MT shortening and plantar displacement of MT head. Should be made parallel to plnatar surface of foot to decrase likelihood of KONWN dorsiflxion deformity of MTP
Asia B injury (motor/sensory)
- INCOMPLETE (perianal sensation/rectal sensation, sensation distal to level of injury
- Some Sensory
- NO MOTOR
Tarsal Navicular Stress Fracture Treatment:
Cast immbolization/ NWB
- Usually DX on CT (not seen on PFs)
Oblique diaphyseal rotational osteotomy of MT indications?
bunnionette deformity with IMN of 4-5th GREATER than 12degreess
- for 7-12d you can do medializing chevron osteotomy
- for less than 7d just do chielectomy
Adult spinal deformity extension of contruct to sacrum (benefits/complications)
- improved saggital balance
- increase pseudoarthrosis
When does cauda equine need to be decompressed ?
Within 48 hours - no difference in outcomes if sooner
Treatment of Hallux rigidus in older, low deman patients?
keller resection arthroplasty- removal of proximal portion of proximal phalanx, osteophyte removal
Mortons Extension Orthosis:
- Limits the extension of 1st MTP during push off of gain
- used for hallux Rigidus, TURF Toe
What does release of conjoined tendon in great toe do?
- Hallux varus
- formed by lateral tendon of FHD and adductor hallicus
Potts disease progression:
- TB of the spine (preferential anterior thoracic in children, leave endplates alone
- Adults does NOT progress after disease
- Children (40 ) will progress after resolution of disease
Acute Spinal chord injury steroid dosing
LOADING DOSE: 30mg/kg +5.4mg/kg/hr
<3 hours from presentaiont- for 224 total hours
3-8 hours: for 48 total hours
>8 hours- NO STEROIDS
Hallux rigidus secondary effects
- decrease dorsiflexion
- transverse metatarsalgia/stress fractures
- inverted gait due to decrease dorsiflexion
Critical Lumbar Stenosis measurements?
- <10mm on AP
- , 100mm2 on cross section on axial CT
C1 lateral mass screw trajectory?
10d medial
22c cephalad
Anterior Tarsal tunnel syndrome:
Radiation to dorsal 1st web space
- compression of DPN in the anterior tarsal tunnel
Most common location of Mortons neuroma?
between the 2-3rd MT heads, transverse intermetatrsal ligament
Baxters Nerve?
1st branch of lateral plantar nerve. May have tinels aat plantar medial heel with pain that radiates to 5th toe
Flexk sign lateral to fibula?
pathonogmonic for superior peroneal retinaculum and peroneal dislocation: PT->then may repair/tenodesis
Most common site for DPN entrapment?
THe inferior extensor retinaculum
Cavus Muscle Imbalances:
TA weak, Peroneal Longus Strong
Posterior tib stron, peroneal brevis weak
Cavus Foot deformity:
- cavus
- Hindfoot varus
- Forefoot pronation
Coleman block determines flexibility of hindfoot
Non flexible hindfoot in cavovarus?
Will need cacl osteotomy
“Floating toe deformity”
- Usually due to Weil osteotomy used for metatosalgia.
Cavovarus foot correction algorithim and coleman blcok:
- ID’s supple hindfoot or not- tell you if the cavus is driven by 1st ray or NOT. IF it corrects with block then driven by 1st ray, would correct with dorsiflexion osteotomy
Resection of Tibial sesamoid?
Hallux Valgus
Resectin of Fibular sesamoid?
Hallux Varus
Resection of both sesamoids?
cock up toe deformity
Large DMAA (>10)?
Needs BIPLANAR chevron rather that normal chevron distal osteotomy
Hallux Valgus Interphalangenous?
- > 10d
- needs Akin (medial closing wedge) osteoetomy of proximal phalanx
For joint inconcruence in hallux valgus, what does it need?
Distal soft tissue correction as well
PTTI- acquired adult flat foot deformities?
- Hindfot valgus,
- Forefoot adbduction
- Forefoot Varus
- Planus
- Mearys >4, Decrease calcaneal pitch, Decrase medial cuneiform floor height
PTTI Stage IIA
- Flatfoot
- NO Single Leg raise
- Flexible hindfoot
- NORMAL Forefoot
PTTI IIB
- Flatfoot
- no SLR
- Flexible HIindfoot
- FOREFOOT ABDCUTION
RIGID hindfoot in PTTI indicates what intervention?
Need for arthrodesis
- Usually TRIPLE
Acessory muscle/tendon in peroneal tendon sheath?
Peroneous Quartus- may be found in up to 21% of patients, increases volume of sheath
What type of receptors activate the NF-kB pathway?
Toll-like receptors
- Leads to production of MMPs
- Stromelysins subgroup of mMPs
Pathologic Scoliosis causes?
- Osteoid osteoma (<1cm)
- Osteoblastoma (>1.5cm)
- Curves usually RIGID, occurs at APEX of deformity
- osteoblastoma more likely to have neuro copromise (size)
- Usually in posterior elements
Pediatric Spinal Tumors and their locations?
- Osteoid Osteoma- Posterior elements
- Osteoblastoma- Posterior elements (>1.5cm)
- Osteochondroma (PE, more cartilage
- Osteogenic Sarcoma- PE
- ABC- vertebral body
- Eosiniphilic granuloma- Cervical- vertebral body
What is best predictor of AIS curve progression?
peak growth velocity:
- occurs in females jest BEFORE menarche and Risser Stage I
- GIrls usually skeletally matrue 1.5 years after menarche
Increase kyphosis, chin on chest, increased chin-brow-vertical angle?
Ankylosis spondylitis
- May need PSO (30-40d correction per level)
- Vertebral resection
- C7-T1 osteotomy
- Chin on chest needs C7 pedical removal (Posterior extension osteotomy)
Prolonged delivery, lack of shoulder adbuction or ER?
Brachial plexopathy from birth
- Erbs better prognosis than Klumpke’s
- Erb’s- Upper nerves 5/6
- Klumpke’s- lowers8/T1
(have glenoid retorversion, posterior subluxation
- may nee Lat transfer, humerusER osteotomies- late disease
What is a Putti sign?
compensatory scapulothorasic motion to ADDUCT the arm resulting in prominence of the superiormedial border of the scapula
Adult Halo traction?
4 PINS at 6-8lbs of traction
- safe zone is 1cm above and lateral 2/3 of orbit
- most common complication is CN VI _lateral rectus
- M->Supratrochlear–>Supraorbital->Lateral
Cascade of superior facet facing in subaxial spine?
Goes from posterior medial in cephalad regions to posterior -lateral is caudal regions
Flattened Facies, multiple joint dislocations, ligamentous hyperlaxity?
Larsens Syndrome
- radial head, knees are common dislocations
CERVICAL KYPHOSIS must be watched
Chances of motor recovery of infant with total brachial plexus palsy AND Horners syndrom?
<10%
Administration of BMP-2 at time of definitive fixation for Type IIIA and IIIB tibia fractures has shown what?
decreased risk of future bone grafting procedures needed
Spondylolisthesis not seen on initial plain films, what is most sensitive study?
Bone scan with SPECT
What are the joints WITH intra-articular metaphysis?
Hip, shoulder, elbow, ankle
NOT the KNEE
What is Type I Muscle?
- Slow twitch, needs O2, Aerobic, endurance
- Endurance training increases capillary denisty
Strength training does what to muscle units?
- increase recruitment
- hypertrophy>hyperplasia
Outerbridge classiciation
0- Normal Cartilage 1- Cartilage Softening and swelling 2- Fissues on surface that do NOT rach subchonral bone 3- Fissuring to subchondral bone 4- Exposed subchondral bone
Transcription factors that lead to osteoclastogenesis?
RANKL
MCSF
Where is most common locations of osteochondritis dessicans lesion?
MFC
- Doesn’t always involve cartilage, primarily lesin of subcondral bone, best predictor is open physis for recover
What is most specific marker of osteoblast maturity?
Osteocalcin:
Percutaneous Screw Fixation for femoral neck stress fracture indications?
- Tension sided fractures
- Compression sided fractures that extend >50% across neck
Sausage digit, nail pitting, “pencil in cup” diagnosis?
Psoriatic arthritis
What Risser Stage does Peak Growth Velocity Occur in?
Risser Stage 0
- Olecranon fuses before initiation of Risser I–>5
What is the main bood supply of the ACL?
Middle geniculate artery- branches from popliteal
- PCL also from MGA (hemarthrosis)
- Lateral and medial mesnisci (from inferior medial/lateral geniculate arteries)
Rhuematoid arthritis ?
- Periarticular erosions, symmetric joint degen, no osteophytes
- Protrusio acetabuli, spares IP
- MCP degen, ULNAR drift–> late disease get MCP arthroplasty
Absolute contraindication to meniscal transplant?
- Varus mal-alignment
- ACl deficient
- Grade IV chondromalacia
- inflammatory arthritis
ACL is primarily composed of what type of collagen?
90% TYPE I
- Dupuytrens contracture? Type III
Enzyme in alkaptonuria (ochronosis)?
Homogentisic acid oxidase
- early arthritis , blackened on gross spec
- dark urine
What molecule responsible for water content in nucleus pulposis?
AGGRECAN(ketarin and chondroitin sulfate)
- major contributor to COMPRESSIVE strength
Nulceous pulp: type II collagen- tensile strength
Annulus- Type I collagen- tensile strength
Zone of cartilage”
Superficial: collagen PARALLEL to JOIN- LOW Proteoglycan
Intermedia: Random
Deep: Perpindicular to joint, HIGH Proteoglycan
Tidemark
With a retorverted pelvis, what would be tight?
Hip flexors and hamstrings
- can be seen in hyperlordosis of spondylolisthesis
Statistical Power Definition: finding as significant association when one truly exist–>formula
often set at 80%
- Type II error= incorrectly assuming th NULL hypothesis (there is true difference but you reject it)
Type I error: incorrectly REJECTING the null hypothesis
Discoid meniscus surgery indications?
- persistent pain or MOTION loss
What is the lung met potential of giant cell tumor of bone?
4%
What are the signs of rheumatoid cervical spondylitis?
- Basilar invagination
- Subaxial instability
- atlanto-axial subluxation
What is classic appeareance of vertebral hemangioma?
vertical striations in the vertebral body seen on saggital (on axial imaging would be boney spots)
Langerhan’s histocytosis stain?
CD1
- birbeck ganules seen in cells
Cancellous and cortical bone remodeling?
- Cortical- cutting cone, osteoclastic tunneling
- Cancellour/Trabecular Bone ( Osteoclastic resorption)
Cervical Stenosis Values?
> 13 nl
10-13mm- relative stenosis
<10mm absolute stenosis
Torg Ratio: <0.8 (canal/cervical body) -saggital
What is the most common child-hood SOFT-tissue sarcoma?
Rhabdomyosarcoma
Cohort versus case control study
Cohort- has risk and look to see disease
Case /Control- has case/disease- look back to see risk
What is cascade of YOungs modulus?
- Ceramic
- Alloy (Co-Ch)
- Stainless steel (iron-carbon allow, molybdenum, Mg)
- Titanium
- Cortical Bone
- PMMA
Cancellous bone
Tendon/ligaments/cartilage
Differential of Small, round, blue cell tumors?
- neuroblastoma -<5yo
- ewings sarcoma 5-15yo
- Langerhans cells
- lymphoma 15-40yo
- Myeloma
- small cell lung carcinoma
ZPA
AER
Sone of polarizing activity- Radial-ulanr growth
Apical ectodermal ridge:- logitudnal growth
Synovial Cell Sarcoma appearance nad translocation
- Biphasic
- X-19
Weinstien Group II
Cerebral palsy scoliosis with >15d of pelvic obliquity
- instrumentation to pelvic decrease late re-curreance and pseudarthrosis . With pelvic obliquity <15d can stop at L4/5
Indications for Mehta casting (derotational) in infantial scoliosis?
RVAD >20d
Scoliosis >30d
What could increase pseudarthrosis risk in patients with surgical ADULT idiopathic scoliosis?
- Saggital balance > 5cm
- Thoracoabdominal apporach
- Age greater than 55
TLICS scoring value for surgery?
> 4
Morphology (compression1, burst2, translation/rotation3, distration4
PLC: intact0, unsure2, out3
Neuro: normal, nerve root, incomplete 3, complete 2, cauda equina 3
Fusion of the olecranon apophysis occurs at what age and in what direction?
- Anterior to posterior
- from 15-17
Ewings sarcoma Treatment?
Translation?
11:22
CD 99 stain
CHEMO, RESECTION, RADIATION; all three
Chemos is Vincristine/Doxorubicin/Dapto
Osteosarcoma treatment algo?
Chemo (MTX) + Wide resection/amputation
What is most common site of metastasis for osteosarcoma?
LUNG»Bone(second)
What does over-resection fo posterior femoral condyles in PS knee cause?
Flexion instability (without dislocation)
Atlantoaxial rotatory instability SCM relationship:
The CHIN will roate to side OPPOSITE of Facet subluxation of C1
- The SCM with we spastic 2/2 to that and be spastic on SAME side as chin
- in congenital torticollis, the SCM is spastic on OPPOSITE side of chin
NON-op fails–>C1/C2 fusion
What are the common organisms of CHRONIC PJI
- Coagulase Negative STAPH and Proprionibacterium
Pleomorphic Sarcoma treatment?
Chemo, WR/ chemo. Like osteosarcoma. WIll look like it in imaging but Histo will be spindle cells, no osteoid
What is the birfucate ligament in the foot?
Attaches to anterior process of the CALC to the Cuboid and navicular. Can cause boney avulasion fracture with pain on lateral aspect of foot
PTHrP does what at the physis level?
Slows the maturation of proliferating chondrocytes
Two sample T test vesus Mann-Whitney?
BOTH are for two MEANS
- Two sample T- Parametric data
- MW- NON-parametric data
Myxoid Liposarcoma translocation?
12: 16
(2: 13)- alveolar rhabdomyosarcoma
What is FDA approved medicaiton for treatment of Giant Cell tumor of bone?
Denosumab
Treatment for Mulitple myeloma?
- Surgical stablization
- RADIATION
- BISphosphonates
Dabigatran MOA?
Direct Thrombin Inhibitor
Rivaroxaban MOA?
Direct Facot Xa Inhibitor
Heparin works via MOA?
Activation of antithormbin III (ATIII)
What is the severe form of Lanherhand Cell histiocytosis that invovled visceral organs?
Hans-Shuller-Christian disease
What spinal lesion is typical for Eosiniphillic granuloma?
Vertebra plana
Coast of Maine hyperpigmentation?
McCune-Albright syndrome
- Polyostotic fibrous dysplasia
- Precocious puberty
- endocrine distrubances
Anti CCP is a marker for what ?
Rheumatoid Arthritis
Side Effects
- Bleomycin?
- Doxorubicin?
- Bleomycin- pulmonary fibrosis
- Doxirubicin: cardiomyopathy
Giant cell tumors are usually NOT found in patients with open growth plates
THink UBC or ABC
How long can you wait in ExFix in Femur? Tibia?
Femur- 3 weeks
Tibia- 7-10days
Indications for Uni Arthroplasty?
- ACL competent
- , 10 d of mechanical axis off
- , 15 d of flexion contracture
- Non- inflammatory arthritis
Botulinum works at what portion of synapse?
At PRESYNAPTIC release of ACH
What do you haev to gt in JIA before surgery?
Cervical radiographs for instability
Where and when do Chondroblastomas occur?
Usualy epiphysiUsualydo NOT occur after PHseal closure
SNAC WRist Progression?
Scaphoid NON unioin advanced colapse 1. radioscaphoid/radiostyloid 2. scaphoid capitate 3. Pancarpal RADIOLUNATE is usually fine PRC for 4CF- Have to do 4CF is capitate head is fucked
Does volumtric wear rates in MoM hips follow typical increase in head size, increase in wear patter?
No because of incrase sliding speed in larger head
- though to be comparable volumetric rates at 28 and 36 due to this
Wear rates are independent of femoral head size between what sizes?
28-42mm
Most common complications withTKA follow HTO?
- Patellar Baja
- Diffcult exposure
- Instaiblity
Metabolic Syndrome constellation?
HTN
HLD
Glucose intolerance
Central Obesity
Stages of Perlunate dislocation ?
- SL ligament
- Luno- Capital articular
- LT ligament
- DRC ligament
Continuous Variables NORMAL distribution test?
Student t test
Continuous Varibles NON NORMAL distrubtion test?
Man Whitney U Test
Two groups of categorical variables?
Chi -Square Test
More than Two groups of variables
ANOVA